Private equity takeovers are harming patients
Ahir parlava del volum de les inversions del capital-risc al sector salut. Avui toca mirar quin ha estat el seu impacte en termes de resultat de salut, costos i qualitat. Faré referència a un article del BMJ de fa pocs mesos. Es tracta d'un tema complicat perquè quan es fa una revisió sistemàtica resulta difícil ajustar per les característiques de l'entorn on es desenvolupa l'activitat. Ara bé, tot i sabent això, els autors estudien 55 casos en 8 països, tenint en compte que 47 són als USA..., els resultats són:
Nursing homes were the most commonly studied healthcare setting (n=17), followed by hospitals and dermatology settings (n=9 each); ophthalmology (n=7); multiple specialties or general physician groups (n=5); urology (n=4); gastroenterology and orthopedics (n=3 each); surgical centers, fertility, and obstetrics and gynecology (n=2 each); and anesthesia, hospice care, oral or maxillofacial surgery, otolaryngology, and plastics (n=1 each). Across the outcome measures, PE ownership was most consistently associated with increases in costs to patients or payers. Additionally, PE ownership was associated with mixed to harmful impacts on quality. These outcomes held in sensitivity analyses in which only studies with moderate risk of bias were included. Health outcomes showed both beneficial and harmful results, as did costs to operators, but the volume of studies for these outcomes was too low for conclusive interpretation. In some instances, PE ownership was associated with reduced nurse staffing levels or a shift towards lower nursing skill mix. No consistently beneficial impacts of PE ownership were identified.
El resum és que estem davant d'un desori descomunal, un resultat al que no desitjaríem mai arribar i menys si som pacients.
A les conclusions, insisteixen en els missatges:
Trends in PE ownership rapidly increased across almost all healthcare settings studied. Such ownership is often associated with harmful impacts on costs to patients or payers and mixed to harmful impacts on quality. Owing to risk of bias and frequent geographic focus on the US, conclusions might not be generalizable internationally.
Hi ha motius profunds per seguir d'aprop aquesta tendència i el seu impacte. Tot allò que es pugui fer per atenuar l'impacte negatiu a la societat, cal impulsar-ho el més aviat possible. Evidentment, ens trobem davant d'un problema regulatori i el regulador segueix de vacances.
PS. Com sempre, cal assenyalar que tota generalització sobre un concepte necessita atendre als matissos de cada cas concret. I per tant parlar de capital-risc en general pot ser inacurat, caldria precisar més per a poder generalitzar després.
PS. Malauradament no trobem cap estudi semblant per al nostre país, i ahir veiem que la posició no era precisament a la cua.
